Children and adolescents with food allergies appear to fare worse physically, socially, and emotionally, and have poorer overall health-related quality of life (HRQL) than their food-allergy-free peers, a new systematic review suggests.

“Findings from the current review suggest that food allergy has a negative impact on the HRQL of children and teens, particularly older children and those with severe food allergy,” the authors write in Pediatric Allergy and Immunology. “By comparison, the link between food allergy and psychosocial functioning is less clear.”

“Evidence from the qualitative literature suggests that the burden of childhood food allergy largely stems from worries surrounding exposures outside of the home and the social consequences of the condition,” they add.

Lead study author Michael A. Golding, MA, a research coordinator at Children’s Hospital Research Institute of Manitoba in Winnipeg, Canada, and his colleagues searched PubMed, Scopus, PsycInfo, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases on several days between November 2019 and March 2021 for peer-reviewed articles published in English in any year.  

They reviewed articles focused on HRQL, psychological health, or social well-being in children and teens with food allergy from birth through 19 years of age. Food allergy comprised both immunoglobulin E (IgE)-mediated food allergies and non-IgE-mediated allergies, including food protein-induced enterocolitis, enteropathy, and proctocolitis.

From the 3789 publications the researchers screened, they included 8202 patients in 45 studies in their quantitative synthesis and 186 patients in 9 studies in their qualitative synthesis. Using a segregated, mixed research synthesis design, they analyzed and synthesized the quantitative and qualitative articles separately, then integrated those findings.

Navigating Through Many Challenges

The authors found that food allergy lowered the young people’s HRQL. In 11 of the 14 studies (78%) that included a comparison group, young patients with food allergy showed significantly lower HRQL in at least one domain. Most significant differences occurred in domains related to total HRQL (66%), social functioning (58%), emotional functioning (54%), and physical functioning (54%). 

• Parents were often more likely than their child to perceive that the child’s food allergy was causing problems.

• Between 20% and 32% of children reported bullying related to their food allergy. Many children reported that their allergy sometimes isolated them from their classmates.

• Many children described feeling comfortable at home but worried in places where they had less control, such as school, restaurants, or when traveling.

• Children and teens tended to downplay their limitations and the negative impacts of their condition.

• Older children who had been diagnosed early in life tended to accept managing their food allergy as a way of life, whereas those diagnosed when they were older reported the need to adapt, accept, and grieve the loss of foods and experiences.

Kelly Marie O’Shea, MD, an assistant professor of allergy and immunology at University of Michigan Health in Ann Arbor, told Medscape Medical News, “This study highlights the importance of addressing the underlying impact that food allergy can have on patients’ mental health and social functioning.”

Dr Kelly Marie O’Shea

“While it has been shown previously that food-allergic patients have lower HRQL, this systematic review aptly reveals that for children and teens with food allergy, overall quality of life, including psychosocial functioning, can also be negatively affected,” said O’Shea, who was not involved in the study.

“Symptoms of anxiety and depression are reported at higher rates in the food-allergic population, and social limitations have been shown to play a role,” she explained. “However, as revealed in this study, longitudinal and appropriately controlled studies to investigate the impact of food allergy on psychosocial outcomes in children and teens are scarce.”

Dr Robert Alan Wood

Robert Alan Wood, MD, a professor of pediatrics at Johns Hopkins University School of Medicine, and the director of pediatric allergy and immunology at Johns Hopkins Children’s Center in Baltimore, Maryland, told Medscape Medical News that the effects of food allergy on mental health are not fully appreciated by the public or by many clinicians.

“These findings emphasize the need to recognize the emotional consequences of food allergy and to take steps to be proactive in managing these issues among our patients,” said Wood, who was not associated with the research.

More Research Is Needed

The authors note that more research is needed to examine links between food allergy, HRQL, and psychosocial outcome; links between food allergy and bullying; and how challenges change over time. They recommend exploring the relative impacts of specific types of food allergy and whether specific traits in young people with food allergy make them more susceptible to its psychological effects. They also call for efforts to identify and help young people with food allergy overcome their many challenges.

The study was funded by the Canadian Institutes for Health Research, the Children’s Hospital Research Institute of Manitoba, and the University of Manitoba.

Study senior author Jennifer L. P. Protudjer, PhD, reported involvement with Canada’s National Food Allergy Action Plan and Allied Health at the Canadian Society of Allergy and Clinical Immunology, and receipt of fees from Novartis. The remaining authors, as well as O’Shea and Wood, reported no relevant financial relationships.

Pediatr Allergy Immunol. Published online March 1, 2022. Abstract

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